Tubulointerstitial nephritis and uveitis syndrome

Uveitis in association with tubulointerstitial nephritis is a distinct clinical entity known as tubulointerstitial nephritis and uveitis(TINU) syndrome. The onset of uveitis most commonly follows the onset of the interstitial nephritis, but may also occur before or concurrently. The uveitis is usually bilateral, nongranulomatous, limited to the anterior segment, and generally responds well to topical or oral (when indicated) anti-inflammatory treatment. Interestingly, recurrent or chronic uveitis is common, in contrast to the tubulointerstitial nephritis, which typically resolves completely.

Approximately 5 months after a biopsy confirmed the diagnosis of tubulointerstitial nephritis, a 13-year-old boy was brought to our clinic with symptoms of a red, photophobic right eye of 3 days duration. Examination revealed nongranulomatous anterior-segment inflammation in the right eye greater than the left. The uveitis responded very well to topical steroid and cycloplegic treatment. Follow-up examinations have shown a gradual decrease in the inflammation, with no ocular complications.

TINU syndrome is an under-recognized disorder and may account for some cases of uveitis otherwise characterized as 'idiopathic." Since the uveitis may be the presenting sign in up to 36% of cases of TINU syndrome, it is important for eye care practitioners to consider this disorder when searching for systemic associations with uveitis. Prompt detection through referral or testing will allow speedy diagnosis and appropriate treatment for both the uveitis and the tubulointerstitial nephritis.